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Review Article | DOI: https://doi.org/10.31579/2639-4162/338
Candidate of biological science, Assistant professor of pathophysiology department named D. A. Maslakov, Grodno State Medical University; Grodno State Medical University, 80 Gorky St,230009, Grodno, Belarus.
*Corresponding Author: Candidate of biological science, Assistant professor of pathophysiology department named D. A. Maslakov, Grodno State Medical University; Grodno State Medical University, 80 Gorky St,230009, Grodno, Belarus.
Citation: Bon L.I., Maksimovich N.Ye., Varabyou H.Y., Kharyk А.А, (2026), False Hermaphroditism, J. General Medicine and Clinical Practice, 9(4); DOI:10.31579/2639-4162/338
Copyright: © 2026, Bon L.I. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 17 February 2026 | Accepted: 26 February 2026 | Published: 02 March 2026
Keywords: false hermaphroditism; disorders of sex development; intersex conditions; androgen insensitivity syndrome; clinical manifestation, pathogenesis
This article examines the challenges associated with the condition known as false hermaphroditism, detailing its pathogenetic mechanisms and diagnostic complexities. It also addresses potential complications affecting various organ systems and the social difficulties faced by patients with these conditions.
False hermaphroditism is a clinical term describing a condition where an individual exhibits a discrepancy between their internal gonads (testes or ovaries) and the development of external genitalia (phenotype) [1]. A key manifestation is genital ambiguity, where the structure of the genitalia is intermediate between typical male and female forms.
Two conditional forms of this condition are distinguished:
1. Male pseudohermaphroditism: Characterized by the presence of testes and a 46, XY karyotype; however, the external genitalia or secondary sexual characteristics display female-like traits [2]. 2. Female pseudohermaphroditism: In this form, ovaries and a 46, XX karyotype are present, but virilization (masculinization) of the external genitalia is observed [1, 2]. It is important to differentiate pseudohermaphroditism from true hermaphroditism—an extremely rare condition where an individual simultaneously possesses both ovarian and testicular gonadal tissue [1]. Both types of pseudohermaphroditism belong to the spectrum of intersex variations. This group encompasses various congenital conditions characterized by atypical, mixed combinations of male and female anatomical features [1]. Terms such as intersex, pseudohermaphroditism, hermaphroditism, sex reversal, and gender diagnostic designations are particularly controversial. Patients may perceive them as potentially derogatory, and for physicians and parents, they can be confusing. The term "Disorders of Sex Development" (DSD) is proposed for use, defined as congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is atypical [3].
46, XX DSD
Female pseudohermaphroditism (46,XX DSD) develops due to: abnormalities in ovarian development (ovotesticular DSD, gonadal dysgenesis, testicular DSD); excessive androgens in the prenatal period, fetal (21-hydroxylase deficiency, 11-hydroxylase deficiency), fetoplacental (aromatase deficiency, cytochrome P450 oxidoreductase deficiency — POR), or maternal (luteoma, maternal androgen drug use) origin; as well as other developmental anomalies, such as cloacal exstrophy, vaginal atresia, or MURCS syndrome [4].
46, XX DSD Clinical Evaluation
Clinical signs that may suggest a disorder of sex development in a newborn include: isolated clitoral hypertrophy, isolated posterior hypospadias, bilateral cryptorchidism or testicular ectopia, as well as unilateral cryptorchidism or ectopia combined with hypospadias or micropenis [5, 6]. In adolescence, virilization of external genitalia, delayed puberty, or primary amenorrhea may be indicative. Clinical assessment involves a precise description of the genital tubercle size, the presence or absence of labial fusion, the number and location of orifices, and palpation of the gonads in the labial-scrotal region. Based on this data, the Prader scale [6,7] is used to objectively assess the degree of genital masculinization, encompassing five stages: I — clitoromegaly without labial fusion; II — clitoromegaly with partial fusion of the posterior labia without the formation of a urogenital sinus; III — marked clitoromegaly with near-complete fusion of the folds and a single urogenital orifice on the perineum; IV — formation of a penis, complete fusion of the folds, a urogenital sinus with an orifice at the base of the penis; V — a fully formed penis and scrotum-like folds without palpable gonads, with the urethra terminating distally [8].
Additionally, a quantitative index of external masculinization can be calculated by assigning points to the following parameters: penis/clitoris size (from 0 — micropenis to 3 — normal), degree of labial fusion (from 0 — absent to 3 — complete fusion), location of gonads (for each: 0 — abdominal or non-palpable, 1 — inguinal, 1.5 — labial-scrotal), and urethral meatus location (0 — perineal, 1 — mid-shaft, 2 — distal, 3 — apical) [9]. Measuring blood pressure is an obligatory component of the examination, which is particularly significant for diagnosing certain forms of congenital adrenal hyperplasia. Following the clinical examination of the external genitalia, an essential step is instrumental visualization to assess internal structures: the urogenital sinus, Müllerian derivatives, gonads, adrenal glands, and in some cases, the urinary tract, due to their shared embryological origin [9,10].
The primary imaging method is ultrasound. However, its capabilities are limited in identifying dysgenetic or fibrous gonads, intra-abdominal testes, and the uterus in prepubertal patients – for the latter, re-evaluation with estrogenization may be required [9]. When ultrasound has low diagnostic value, particularly for assessing Müllerian derivatives, ectopic or dysgenetic gonads (though testes located outside the abdominal cavity are usually visualized satisfactorily), as well as associated congenital anomalies of the urinary system, magnetic resonance imaging (MRI) is recommended [10, 11].
The examination focuses on the pelvic region and perineum, extending to the abdominal cavity if assessment of the adrenal glands or tumor formations is necessary. Although genitography can be used to characterize internal reproductive pathways, it is often replaced by genitoscopy – an endoscopic method that provides direct visualization and precise determination of the anatomical relationships between the urogenital sinus, Müllerian structures, and the urethra [9]. Laparoscopy is indicated in cases requiring direct intraoperative revision of gonads for their visualization, biopsy, or removal of intra-abdominal masses [12].
46, XX DSD Metabolism
21-hydroxylase deficiency (caused by CYP21A2 mutation) leads to a metabolic block in aldosterone and cortisol synthesis, making it impossible to convert progesterone to deoxycorticosterone and 17-hydroxyprogesterone to 11-deoxycorticosterone, while the substrates are utilized for androgen synthesis [13, 14]. Cortisol synthesis deficiency results in ACTH stimulation. The enzyme 11β-hydroxylase (encoded by CYP11B1, expressed in the fasciculata zone) is involved in the metabolism of deoxycortisol to cortisol. Deficiency of this enzyme leads to cortisol deficiency and, consequently, elevated ACTH levels without mineralocorticoid deficiency. This results in glandular hypertrophy, and the excessive diversion of unmetabolized substrate towards androgenic metabolism causes virilization in girls. The enzyme deficiency leads to the accumulation of 11-deoxycortisol and 11-deoxycorticosterone [13].
There are two isoforms of 3-βHSD (3-beta-hydroxysteroid dehydrogenase): type 1 and type 2, which differ by 23 amino acids. Type 1 is expressed in the liver, skin, placenta, or prostate gland, while type 2 is exclusively expressed in the adrenal glands and gonads. Moreover, 3-βHSD type 2 deficiency occurs in less than 0.5% of patients with congenital adrenal hyperplasia and is caused by impaired metabolism of ∆5-steroids into ∆4-steroids, affecting all three corticosteroid hormone lines, thus reducing the synthesis of mineralocorticoids, glucocorticoids, androgens [15].
∆5-steroids (17-hydroxypregnenolone, DHEA, DHEAs) possess low androgenic activity, but their excessive accumulation leads to virilization of the external genitalia in patients with a 46, XX karyotype. The protein ferrying POR acts as an electron donor from NADPH to microsomal steroidogenic enzymes and influences the synthesis of glucocorticoids and sex hormones, affecting the action of enzymes encoded by CYP21A2, CYP17A1, or CYP19A1 [16]. Additionally, skeletal abnormalities may be observed due to insufficient interaction of POR with enzymes involved in sterol synthesis (CYP51A1, SQLE, CYP26A1, CYP26B1, CYP26C1). Thus, POR deficiency leads to impaired steroidogenesis (cortisol and sex hormones – causing DSD) and skeletal malformations, the phenotype of which resembles Antley-Bixler Syndrome. Glucocorticoid synthesis impairment is typically partial, with basal cortisol levels being normal but showing an anomalous response to stress, and elevated mineralocorticoid levels may also be observed, which are responsible for possible high blood pressure in these patients [17].
Glucocorticoid receptor deficiency is caused by loss-of-function mutations in the glucocorticoid receptor (NR3C1), leading to glucocorticoid resistance (elevated cortisol levels but no clinical signs of hyperfunction) and increased ACTH levels. This, in turn, stimulates the synthesis of adrenocortical hormones (aldosterone, cortisol, and androgens), manifesting clinically as hypertension, hypokalemia, virilization in females, and premature pubic hair and hirsutism [18].
Aromatase catalyzes the conversion of C19 androgens to C18 estrogens, playing a crucial role in the placenta and postnatally as a key enzyme in estrogen synthesis. Placental aromatase deficiency leads to elevated androgen levels, which return to the fetal circulation and cause virilization in patients with a 46, XX karyotype [18].
Consequences of 46, XX DSD
For 46, XX newborns with significant genital masculinization, sex determination initially evokes shock and doubt. In some cultures where males are traditionally preferred, such infants may be mistakenly assigned the male sex, and correcting this error later can be extremely difficult [19-21].
Considering data on the good adaptation of patients with 46, XX CAH raised as boys, as well as the risks of feminizing surgery for cosmetic and sexual function, some experts suggest intentionally raising such newborns as boys, despite the loss of fertility and the need for lifelong androgen therapy [22]. This approach is supported by the masculinizing influence of prenatal androgen excess on behavior and gender role preferences, which may lead to gender confusion and transgender identification [23-28]. However, the majority of adolescents and adults with 46, XX CAH raised as girls maintain a female gender identity; only 5.2% of 250 individuals reported serious issues in this area [29].
Atypical genital development is associated with severe psychosocial complications: the formation of awareness regarding the discrepancy between external appearance and registered sex, conflicting gender perception within the family environment, increased attention and stigmatization from society, and body image disturbance, which can be exacerbated by short stature, excessive body weight, and hirsutism [30]. The totality of these factors contributes to social self-isolation, avoidance of situations involving undressing (e.g., sports or medical examinations), and rejection of romantic and sexual relationships.
Adrenal neoplasms are detected in 1–4% of healthy men and women, and their incidence increases with age [31-32]. In the work by Jaresch et al., where computed tomography was used to examine adult DSD patients with CAH, a high frequency of benign adrenal tumors was noted, especially in the group receiving insufficient glucocorticoid therapy [33]. Adrenocortical carcinomas are rare in CAH patients; only one case in pediatric practice has been described in the literature [34-35]. Several adults with CAH developed massive adrenal myelolipomas, which required surgical removal to alleviate symptoms [36]. Children with CAH have a higher BMI than the control group due to increased fat mass [37]. Approximately half of pediatric patients are overweight, and 16% to 25% suffer from obesity [37-39]. Women with DSD secondary to CAH are often overweight [41-43], but in patients around 30 years old, fat mass was similar to that of the control group. Few of them had hypertension, cardiovascular disease, or diabetes. The most significant metabolic disturbance was a 20% prevalence of gestational diabetes, which is somewhat higher than the general population prevalence estimated at 7-10% but ranging from 1% to 25% [38].
Individuals with congenital adrenal hyperplasia (CAH) who did not receive intrauterine dexamethasone treatment may experience a reduction in working or short-term memory [44,45]. Furthermore, women with CAH show lower scores in tests of working memory, processing speed, digit span, and matrix reasoning compared to a control group [46]. Magnetic resonance imaging revealed structural changes in white matter, hippocampus, thalamus, cerebellum, and brainstem; magnetic resonance spectroscopy also recorded a decrease in choline levels in the temporal lobe. Notably, these deviations were more pronounced in patients receiving higher doses of glucocorticoids [46].
46, XY DSD
Male pseudohermaphroditism (46,XY DSD) can be caused by the following main groups of reasons: disorders of testicular development (complete or partial gonadal dysgenesis, gonadal regression, ovotesticular DSD); defects in androgen synthesis or action, including enzymopathies (17-hydroxysteroid dehydrogenase deficiency, 5α-reductase deficiency), androgen insensitivity syndromes (complete — CAIS, partial — PAIS), LH receptor disorders (Leydig cell hypoplasia), as well as other anatomical anomalies such as severe hypospadias or cloacal exstrophy [4].
Androgen Insensitivity Syndrome (AIS), complete form (synonyms: Morris syndrome, testicular feminization syndrome, feminizing testes syndrome, male pseudohermaphroditism), is a genetic disorder characterized by a defect in the androgen receptor gene, located on the short arm of the X chromosome (Xq11-12) [47]. This condition is inherited in an X-linked recessive manner and often has a family history [48-49].
The pathogenesis of conditions caused by impaired androgen receptor function is linked to the absence or varying degrees of reduced sensitivity to male sex hormones secreted during the pre- and postnatal periods [50]. Gonadal differentiation proceeds along the male type, but the defect in androgen function implementation causes impaired masculinization and development of the genitalia along the male type. Concurrently, the function of anti-Müllerian hormone is not disrupted; its intrauterine secretion by Sertoli cells leads to the regression of Müllerian ducts (absence of their derivatives – uterus, fallopian tubes). At the same time, estrogens are still secreted by the adrenal glands and partially by the gonads, and due to this influence, a fetus of genetic and gonadal male sex develops a female phenotype [51]. Depending on the degree of androgen resistance, various clinical and morphological manifestations are observed with a 46, XY karyotype: a male phenotype with impaired spermatogenesis and infertility (in adulthood), a male phenotype with isolated micropenis or penoscrotal hypospadias, a female phenotype with partial labial fusion, clitoral hypertrophy and gynecomastia, or a typical female phenotype [52].
Numerous genetic studies have shown that various mutations in the androgen receptor gene AR/HUMARA are the cause of androgen insensitivity (resistance). The probands' mothers are carriers of the mutation in approximately 70% of all cases [53-57]; the remaining 30% of cases consist of de novo germinative mutations, as well as postzygotic mutations, which can lead to somatic mosaicism in patients with androgen insensitivity [58]. Furthermore, it has been noted that a condition similar to incomplete androgen insensitivity can be caused by mutations in the SF-1 (steroidogenic factor-1) gene [59].
Clinical Presentation of 46, XY DSD
Complete Androgen Insensitivity: Due to insensitivity to dihydrotestosterone, female external genitalia develop. In puberty, primary amenorrhea is observed, as the uterus and ovaries are absent. A characteristic diagnostic sign is sparse or complete absence of pubic and axillary hair (the so-called "smooth skin syndrome"), as androgens are responsible for hair growth in these areas. Breast development proceeds normally, explained by the normal estrogen levels formed by aromatization of testosterone. In the postpubertal period, individuals with the complete form of androgen insensitivity syndrome exhibit normal male testosterone levels, higher estrogen and luteinizing hormone (LH) levels, and normal or slightly elevated follicle-stimulating hormone (FSH) levels [60].
Women with the complete form of androgen insensitivity syndrome are typically tall and physically developed. The increased prevalence of this condition among female athletes who have achieved notable sporting success supports the notion that women with complete androgen insensitivity syndrome possess certain physiological advantages over their competitors. Currently, their participation in competitions is regulated by the rules of international sports federations (e.g., World Athletics), which set limits on testosterone levels for specific events, sparking widespread discussion in sports medicine and ethics [60].
Incomplete Androgen Insensitivity. In patients with the incomplete form of androgen insensitivity, reactivity of the body to androgens is partially preserved. Therefore, signs of masculinization are noticeable in the structure of the external genitalia: a hypertrophied clitoris, a funnel-shaped vaginal vestibule, and often vaginal aplasia [61]. The symptoms of the incomplete form of androgen insensitivity syndrome vary widely, which is likely why it has numerous historical names: incomplete AR deficiency, incomplete masculinization syndrome, male pseudohermaphroditism, Reifenstein syndrome, Gilbert-Dreyfus syndrome, and others. However, these do not represent distinct entities and should be considered as different phenotypic variants of the incomplete form of testicular feminization (partial androgen insensitivity). The phenotypic variant where the structure of the external genitalia is close to normal male development is described as Reifenstein syndrome [62].
Unlike the complete form, incomplete androgen insensitivity is typically diagnosed at an early stage of life due to an intermediate phenotype combining masculine and feminine features. In cases of significant pathology, the sex is determined as female; however, clitoromegaly and partial labial fusion are noted, and progressive masculinization may occur during puberty. A urogenital sinus and labial-scrotal fusion may be observed [60]. In cases of less pronounced pathology, such as Reifenstein syndrome, the patient's phenotype exhibits more masculine traits, with male external genitalia potentially presenting with perineoscrotal hypospadias; a small penis may be accompanied by cryptorchidism or testicular location in the inguinal region, and a split scrotum. Typically, gynecomastia develops during puberty. In mild forms of androgen insensitivity, the patient may exhibit all signs of the male sex but be infertile, with isolated hypospadias being the only noticeable sign [60].
46, XY DSD Metabolism
Androgen insensitivity syndrome is the most common cause of sex development disorders in individuals with a 46, XY karyotype. It arises from alterations in the androgen receptor gene, leading to a state of hormonal resistance and can manifest clinically in three phenotypes: complete (CAIS), partial (PAIS), or mild (MAIS) [63].
Type 2 5α-reductase deficiency impairs the conversion of testosterone (T) to its more active metabolite, dihydrotestosterone (DHT), which is essential for the normal development of the external genitalia, urethra, and prostate in the male fetus, whereas testosterone plays the primary role in Wolffian duct virilization. Although testosterone and DHT have specific roles in the process of sex differentiation, their actions are mediated by the same androgen receptor (AR) [64]. The diagnosis of 5α-reductase deficiency is suspected in a newborn with ambiguous genitalia characterized by penoscrotal hypospadias. In fact, the degree of undervirilization of the genitalia in patients with 5α-reductase deficiency has been reported to be highly variable [65-71]. This variability may be attributed to residual enzyme activity, genetic background, or the action of type 1 5α-reductase.
46, XY DSD Consequences
Histological examination of gonadal biopsies from patients with androgen resistance reveals atrophy and hyalinization of the seminiferous tubules, interstitial fibrosis with Leydig cell hyperplasia, indicating tubular damage in the postpubertal period. Furthermore, impaired differentiation and development of male germ cells and a block (arrest) of spermatogenesis are found in the convoluted seminiferous tubules [72]. In most patients with Reifenstein syndrome, impaired sensitivity to sex hormones leads to secretory azoospermia, therefore, male infertility is usually their sole complaint [73].
Androgen insensitivity syndrome often correlates with the occurrence of inguinal hernias, which is a typical diagnostic sign in girls when the process is bilateral. Disruption of the negative feedback mechanism leads to excessive LH secretion, provoking Leydig cell hyperplasia and the formation of Pick's adenomas. Due to the high risk of malignancy in non-functional gonads in the complete form of the syndrome, bilateral laparoscopic gonadectomy is the standard treatment. The intervention is recommended to be performed after the completion of puberty, once breast development is complete and bone growth has ceased [60]. In a study by S. Steinmacher et al., 27 out of 35 patients with XY-DSD underwent gonadectomy, including 10 at the authors' clinic. In 4 of these 10 patients (40%), histological analysis revealed tumors: a seminoma was found in a 23-year-old patient with 5α-reductase deficiency; a seminoma and a Leydig cell tumor were found in a 40-year-old patient with complete androgen insensitivity (cAIS); and bilateral and unilateral Sertoli cell adenomas were found in a 19-year-old and a 20-year-old patient with cAIS, respectively. The average age of patients with tumors was 25.5 years compared to 14.5 years in the operated group, indicating an increased risk after puberty [74].
Summarizing the above, it should be emphasized that false hermaphroditism is a heterogeneous condition requiring thorough genetic investigation. The main trend in managing such patients today is to avoid hasty feminizing or masculinizing surgeries in favor of a watchful waiting approach and careful hormonal monitoring. The prospects for further research lie in studying the long-term quality of life of patients and improving methods of bioethical support for families. Only comprehensive diagnostics and cautious surgical tactics can ensure patients with disorders of sex development achieve full personal and social realization.
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Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).
